Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LPA1231/65 LPA1231/65 ULTIPACE

Facility

$2,000.00

Hospital Charge Code	270705802
Hospital Revenue Code	279
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

LPA1231/65 LPA1231/65 ULTIPACE

Facility

$2,000.00

Hospital Charge Code	270705802
Hospital Revenue Code	279
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.00
Rate for Payer: Oxford Commercial	$400.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Commercial	$400.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

LPD-FLEX ARTICULAR SURFACE

Facility

$5,862.10

Hospital Charge Code	270657958
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

LPD-FLEX ARTICULAR SURFACE

Facility

$5,862.10

Hospital Charge Code	270657958
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

L PLATE 2.3M PRO HD LOCK RI 6H

Facility

$2,725.00

Hospital Charge Code	270669929
Hospital Revenue Code	278
Min. Negotiated Rate	$408.75
Max. Negotiated Rate	$659.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$599.50
Rate for Payer: Qualcare PPO/HMO/WC	$408.75

L PLATE 2.3M PRO HD LOCK RI 6H

Facility

$2,725.00

Hospital Charge Code	270669929
Hospital Revenue Code	278
Min. Negotiated Rate	$65.67
Max. Negotiated Rate	$1,362.50
Rate for Payer: Aetna Commercial	$1,035.50
Rate for Payer: Aetna Medicare Advantage	$817.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$694.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$694.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$694.88
Rate for Payer: Cigna Commercial	$1,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$599.50
Rate for Payer: Qualcare PPO/HMO/WC	$408.75
Rate for Payer: UnitedHealthcare Community & State	$65.67
Rate for Payer: Wellpoint Medicaid Managed Care	$72.21

L-PLATE LCP LF 2HD 3H 2.7x32MM

Facility

$1,620.00

Hospital Charge Code	270667167
Hospital Revenue Code	278
Min. Negotiated Rate	$39.04
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$615.60
Rate for Payer: Aetna Medicare Advantage	$486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.10
Rate for Payer: Cigna Commercial	$810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$356.40
Rate for Payer: Qualcare PPO/HMO/WC	$243.00
Rate for Payer: UnitedHealthcare Community & State	$39.04
Rate for Payer: Wellpoint Medicaid Managed Care	$42.93

L-PLATE LCP LF 2HD 3H 2.7x32MM

Facility

$1,620.00

Hospital Charge Code	270667167
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$392.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$356.40
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

L-PLATE LCP RT 2HD 3H 2.7x32MM

Facility

$1,620.00

Hospital Charge Code	270667166
Hospital Revenue Code	278
Min. Negotiated Rate	$39.04
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$615.60
Rate for Payer: Aetna Medicare Advantage	$486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.10
Rate for Payer: Cigna Commercial	$810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$356.40
Rate for Payer: Qualcare PPO/HMO/WC	$243.00
Rate for Payer: UnitedHealthcare Community & State	$39.04
Rate for Payer: Wellpoint Medicaid Managed Care	$42.93

L-PLATE LCP RT 2HD 3H 2.7x32MM

Facility

$1,620.00

Hospital Charge Code	270667166
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$392.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$356.40
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

L-PLATE OBLIQUE LF 2H 2x20MM

Facility

$234.85

Service Code	HCPCS C1713
Hospital Charge Code	270604340
Hospital Revenue Code	278
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$117.42
Rate for Payer: Aetna Commercial	$89.24
Rate for Payer: Aetna Medicare Advantage	$70.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.89
Rate for Payer: Cigna Commercial	$117.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$51.67
Rate for Payer: Qualcare PPO/HMO/WC	$35.23
Rate for Payer: UnitedHealthcare Community & State	$5.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.22

L-PLATE OBLIQUE LF 2H 2x20MM

Facility

$234.85

Service Code	HCPCS C1713
Hospital Charge Code	270604340
Hospital Revenue Code	278
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$56.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$51.67
Rate for Payer: Qualcare PPO/HMO/WC	$35.23

L-PLATE OBLIQUE LF 3H 2.7x35MM

Facility

$259.55

Service Code	HCPCS C1713
Hospital Charge Code	270604325
Hospital Revenue Code	278
Min. Negotiated Rate	$38.93
Max. Negotiated Rate	$62.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$57.10
Rate for Payer: Qualcare PPO/HMO/WC	$38.93

L-PLATE OBLIQUE LF 3H 2.7x35MM

Facility

$259.55

Service Code	HCPCS C1713
Hospital Charge Code	270604325
Hospital Revenue Code	278
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$129.78
Rate for Payer: Aetna Commercial	$98.63
Rate for Payer: Aetna Medicare Advantage	$77.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.19
Rate for Payer: Cigna Commercial	$129.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$57.10
Rate for Payer: Qualcare PPO/HMO/WC	$38.93
Rate for Payer: UnitedHealthcare Community & State	$6.26
Rate for Payer: Wellpoint Medicaid Managed Care	$6.88

L-PLATE OBLIQUE RT 2H 2x20MM

Facility

$228.00

Hospital Charge Code	270665619
Hospital Revenue Code	278
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.64
Rate for Payer: Aetna Medicare Advantage	$68.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.14
Rate for Payer: Cigna Commercial	$114.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$50.16
Rate for Payer: Qualcare PPO/HMO/WC	$34.20
Rate for Payer: UnitedHealthcare Community & State	$5.49
Rate for Payer: Wellpoint Medicaid Managed Care	$6.04

L-PLATE OBLIQUE RT 2H 2x20MM

Facility

$228.00

Hospital Charge Code	270665619
Hospital Revenue Code	278
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$55.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$50.16
Rate for Payer: Qualcare PPO/HMO/WC	$34.20

L-PLATE OBLIQUE RT 3H 2.7x35MM

Facility

$259.55

Service Code	HCPCS C1713
Hospital Charge Code	270604326
Hospital Revenue Code	278
Min. Negotiated Rate	$38.93
Max. Negotiated Rate	$62.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$57.10
Rate for Payer: Qualcare PPO/HMO/WC	$38.93

L-PLATE OBLIQUE RT 3H 2.7x35MM

Facility

$259.55

Service Code	HCPCS C1713
Hospital Charge Code	270604326
Hospital Revenue Code	278
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$129.78
Rate for Payer: Aetna Commercial	$98.63
Rate for Payer: Aetna Medicare Advantage	$77.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.19
Rate for Payer: Cigna Commercial	$129.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$57.10
Rate for Payer: Qualcare PPO/HMO/WC	$38.93
Rate for Payer: UnitedHealthcare Community & State	$6.26
Rate for Payer: Wellpoint Medicaid Managed Care	$6.88

L-PLATE OBL RT 2HD 3H 2.7x35MM

Facility

$1,620.00

Hospital Charge Code	270667165
Hospital Revenue Code	278
Min. Negotiated Rate	$39.04
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$615.60
Rate for Payer: Aetna Medicare Advantage	$486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.10
Rate for Payer: Cigna Commercial	$810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$356.40
Rate for Payer: Qualcare PPO/HMO/WC	$243.00
Rate for Payer: UnitedHealthcare Community & State	$39.04
Rate for Payer: Wellpoint Medicaid Managed Care	$42.93

L-PLATE OBL RT 2HD 3H 2.7x35MM

Facility

$1,620.00

Hospital Charge Code	270667165
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$392.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$356.40
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

L.PNEUMOPHILA AB(IGM) I

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990102A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

L.PNEUMOPHILA AB(IGM) I

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990102A
Hospital Revenue Code	302
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

L. PNEUMOPHILA AB(IGM)IFA

Facility

$156.85

Service Code	HCPCS 86713
Hospital Charge Code	3035106
Hospital Revenue Code	302
Min. Negotiated Rate	$23.53
Max. Negotiated Rate	$23.53
Rate for Payer: Qualcare PPO/HMO/WC	$23.53

L. PNEUMOPHILA AB(IGM)IFA

Facility

$156.85

Service Code	HCPCS 86713
Hospital Charge Code	3035106
Hospital Revenue Code	302
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna Medicare Advantage	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.23
Rate for Payer: Cigna Commercial	$78.42
Rate for Payer: Cigna Medicare Advantage	$15.30
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.05
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.53
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Medicare Advantage	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$4.16

L.PNEUMOPHILA AB(IGM) II

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990102B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges